Tetanus Flashcards
Factors Associated with a Poor Prognosis in Tetanus
Clinical and pathologic progression of tetanus.
It is caused by a powerful neurotoxin produced by the bacterium Clostridium tetani and is completely preventable by vaccination
Tetanus
When does Tetanus commonly occur?
low vaccination coverage rates
How is Tetanus diagnosed?
Clinical
What is the CDC’s definition of probable Tetanus?
An acute illness with muscle spasms or hypertonia without a more likely diagnosis.
It is defined by the World Health Organization (WHO) as “an illness occurring in a child who has the normal ability to suck and cry in the first 2 days of life but who loses this ability between days 3 and 28 of life and becomes rigid and has spasms.
Neonatal tetanus
It s defined by the WHO as tetanus occurring during pregnancy or within 6 weeks after the conclusion of pregnancy (whether with birth, miscarriage, or abortion).
Maternal tetanus
An anaerobic, gram-positive, spore-forming rod whose spores are highly resilient and can survive readily in the environment throughout the world
C. tetani
Spores resist boiling and many disinfectants T/F
T
What infections are associated with more severe tetanus?
Deeper infections such as those due to open fracture, abortion, or drug injection.
Only bacteria producing tetanus toxin (tetanospasmin) can cause tetanus. T/F
T
What happens after the tetanus toxin binds to nerve terminals?
The toxin is internalized and undergoes retrograde transport to the motor neuron body.
What happens to tetanus toxin after retrograde transport?
After retrograde transport in the motor neuron, tetanus toxin translocates across the synapse to GABA-ergic presynaptic inhibitory interneuron terminals.
What role does the light chain of tetanus toxin play?
The light chain, a zinc-dependent endopeptidase, cleaves VAMP2 (vesicle-associated membrane protein 2), necessary for neurotransmitter release.
What is the effect of tetanus toxin on neurotransmitter release?
It prevents the release of neurotransmitter, blocking inhibitory interneuron discharge, leading to unregulated activity in the motor nervous system.
The most common initial symptoms are
trismus (lockjaw), muscle pain and stiffness, back pain, and difficulty swallowing
The clinical manifestations of tetanus occur only after tetanus toxin has reached ______
presynaptic inhibitory nerves
What happens during the second week of severe tetanus?
Autonomic disturbance peaks, with cardiovascular events becoming the major risk
What are signs of autonomic involvement in tetanus?
Signs include labile blood pressure, tachycardia, bradycardia, heart block, gastrointestinal stasis, sweating, increased tracheal secretions, and acute renal failure.
What is the preferred antibiotic therapy for tetanus?
Metronidazole (400 mg rectally or 500 mg IV every 6 hours for 7 days) is preferred.
What is an alternative to Metronidazole for tetanus treatment?
An alternative is penicillin (100,000–200,000 IU/kg per day), though it may exacerbate spasms and was associated with increased mortality in one study.
It is given early in an attempt to deactivate any circulating tetanus toxin and prevent its uptake into the nervous system
Antitoxin: TIG/Equine antitoxin
The preparation of choice for antitoxin, as it is less likely to be associated with anaphylactoid reactions
TIG
How are spasms controlled
benzodiazepines
What environment is ideal for tetanus patients?
calm, quiet environments to avoid triggering spasms
How long can recovery from tetanus take?
4–6 weeks
Patients must be given a full primary course of immunization as tetanus toxin is poorly immunogenic and the immune response following natural infection is inadequate. T/F
T
What are the catch-up schedules for incomplete primary vaccination in infancy?
For those age 7 years or older, the recommendation is a three-dose primary course with 4 weeks between the first two doses, followed by a booster 6–12 months later.
What are WHO recommendations for maternal and neonatal tetanus prevention?
2 doses of tetanus toxoid at least 4 weeks apart to previously unimmunized pregnant women.
A third dose should be given at least 6 months later, followed by one dose in subsequent pregnancies (or intervals of at least 1 year), to a total of five doses to provide long-term immunity.
What is the recommended airway management method for patients with severe tetanus requiring prolonged ventilation? A. Nasal oxygen
B. Endotracheal intubation
C. Tracheostomy
D. Non-invasive positive pressure ventilation (NIPPV)
Answer: C. Tracheostomy
They should undergo passive immunization with TIG.
What is the role of intravenous magnesium sulfate in the treatment of severe tetanus? A. It increases blood pressure
B. It acts as a muscle relaxant and helps control spasms
C. It serves as an antibiotic
D. It stimulates immune function
B
Which of the following measures is most effective for controlling spasms in severe tetanus? A. High-dose aspirin
B. Benzodiazepines
C. Low-dose ibuprofen
D. Oral antibiotics
B
What is the recommended course of action if a tetanus patient has an incomplete vaccination history and presents with a non-clean wound? A. Administer oral antibiotics only
B. Passive immunization with tetanus immune globulin (TIG)
C. Wait for culture results before starting treatment
D. Prescribe vitamin supplements
B
What serum anti-tetanus immunoglobulin G level is considered protective against tetanus? A. >0.01 IU/mL
B. >0.05 IU/mL
C. >0.1 IU/mL
D. >1.0 IU/mL
C
